ST-elevation Myocardial Infarction Group Research Articles

GW24-e3620 Relationship between plasma ADAMTS-7 and heart failure in acute myocardial infarction patients.

ObjectivesTo detect plasma ADAMTS-7 in acute myocardial infarction patients and the relationship between BNP and ADAMTS-7.MethodsAltogether 42 STEMI (ST elevated myocardial infarction) patients, 30 NSTEMI (non ST elevated myocardial infarction)...

Reperfusion therapy and mortality in octogenarian STEMI patients: results from the Belgian STEMI registry

Treatment strategies and outcome of ST-elevation myocardial infarction (STEMI) have been mainly studied in middle-aged patients. With increasing lifetime expectancy, the proportion of octogenarians will substantially increase. We aimed to evaluate whether the benefit of currently recommended reperfusion strategies is maintained in octogenarians. Reperfusion therapy and in-hospital mortality were evaluated in 1,092 octogenarians and compared with 7,984 STEMI patients <80 years old based on data from the prospective Belgian STEMI registry. The octogenarian STEMI group had more cardiovascular comorbidities, contained more female patients and presented more frequently with cardiac failure (Killip class >1, 40 vs. 20 %) compared with their younger counterparts (all p < 0.05). Although the rate of thrombolysis was similar (9.2 vs. 9.9 %) between both groups, a conservative approach was chosen more frequently (13.8 vs. 4.7 %), while PCI was performed less frequently (76.9 vs. 85.4 %) in octogenarians (p < 0.001). Moreover, ischemic time and door-to-needle/balloon time were longer for octogenarians. In-hospital mortality for octogenarians was 17.8 vs. 5.5 % in the younger group [adjusted OR 2.43(1.92-3.08)]. In haemodynamically stable octogenarians, PCI seemed to improve outcome compared with thrombolysis or conservative treatment (5.7 vs. 12.7 vs. 8.5 %, p = 0.09). In octogenarians with cardiac failure, in-hospital mortality was extremely high independent of the chosen reperfusion therapy (34.6 vs. 31.6 vs. 36.3 %, p = 0.88). In-hospital mortality in octogenarian STEMI patients was high and related to a high prevalence of cardiac failure. Less PCI was performed in the octogenarian group compared with the younger patients, although mortality benefit of PCI was maintained in haemodynamically stable octogenarians.

Retrospective multicenter observational study of the interventional management of coronary disease in the very elderly: The NINETY

The aim of this observational, multicenter study was to describe the outcome of very elderly patients undergoing percutaneous coronary intervention (PCI). There is a paucity of data among nonagenarians undergoing PCI. All consecutive patients 90 years of age or older undergoing PCI with stent implantation between April 2002 and June 2009 were included in the study. The primary endpoint was the long-term rate of net adverse cardiac events (NACE), that is, death, myocardial infarction (MI), target lesion revascularization, and life-threatening or major bleedings. One hundred forty-six nonagenarians were divided in three groups according to clinical setting: 27 (group A) stable angina or silent ischemia, 85 (group B) unstable angina or non-ST elevation MI, and 34 (group C) with ST elevation MI (STEMI). At 30 days, the incidence of NACE was significantly lower in patients in Group A vs. B or C (0% vs. 17.3% vs. 31.2%, P = 0.006), and the frequency of definite stent thrombosis was higher in Group C vs. A or B (9.4% vs. 0% vs. 0%, P = 0.007), respectively. Up to a median follow-up of 24 months, NACE rate was 33.3% in group A, 49.3% in group B, and 50% in group C (P = 0.32). There were no significant differences between groups in the individual components of the primary endpoint. PCI in nonagenarians is safe and feasible with acceptable major bleeding rates. However, long-term results show high mortality rates particularly in the STEMI group.

ASSA13-15-17 The Efficacy and Security Analysis of Interventional Therapy Supported by Intra-Aortic Balloon Pump For Patients with High Risk Coronary Heart Disease

Objective To evaluate the efficacy and security of percutaneous coronary intervention (PCI) supported by intra-aortic balloon pump (IABP) for patients with high risk coronary heart disease. Methods We retrospectively reviewed immediate success rate of PCI, in-hospital survival rate and complications of 624 patients with high risk coronary heart disease who underwent PCI supported by IABP in our institution from January 2000 to October 2011. Results Out of all the 624 patients, 71% were ST-elevation myocardial infarction (STEMI), 21% were none ST-elevation myocardial infarction (NSTEMI) and 8% were unstable angina pectoris (UAP). The patients (averagely aged 68 years and 71% were males) suffered from hypertension (78%), family history of coronary heart disease (34%), abnormal metabolism of serum lipids (69%) and diabetes (45%). The latter two seemed presenting more frequently in patients with acute myocardial infarction (AMI). The incidence of major adverse cardiovascular events (MACE) in STEMI and NSTEMI group was significantly higher than that in UAP group (3.1% and 2.9% vs. 0.01%, P P Conclusions The success rate of PCI for patients with high risk coronary heart disease is extremely high when IABP support was applied, with an ideal prognosis and decreased complications. This method is clinically safe and efficient with high feasibility. The advantages become more evident when treating patients with AMI complicated by high risk of cardiogenic shock.

Plasma Granzyme B in ST Elevation Myocardial Infarction versus Non-ST Elevation Acute Coronary Syndrome: Comparisons with IL-18 and Fractalkine

Objective. The proapoptotic protein, granzyme B (GZB), was identified as a contributor to the atherosclerotic plaque instability and recently as inflammatory activator. We studied the release kinetics of GZB and other markers of inflammation such as high sensitivity C reactive protein (hsCRP), interleukin 18 (IL-18), and fractalkine (FKN) in the early phase after acute cardiac events in different ACS subgroups. Methods. Thirty-six nondiabetic patients with ACS were compared to 12 control subjects. According to ACS diagnosis, the patients were classified into 22 patients with ST elevation myocardial infarction (STEMI) and 14 patients with non-ST elevation myocardial infarction or unstable angina (NSTEMI/UA). Blood samples were taken on day 1 (day of onset) and day 3 to measure hsCRP, IL-18, FKN, and GZB by ELISA. Results. Patients with ACS showed significantly higher GZB, IL-18, and FKN levels than the controls. STEMI group showed significantly higher GZB levels than NSTEMI/UA group. On day 3, FKN levels displayed a significant decrease, while GZB levels were significantly increased. IL-18 levels were more or less constant. GZB levels were positively correlated with IL-18 (r = 0.416, P < 0.01) and FKN (r = 0.58, P < 0.001). Conclusions. Unlike IL-18 and FKN, plasma GZB may be a marker of ACS disease severity.

The relationship between endothelial microparticles in patients with ST-elevated myocardial infarction and myocardial injury

Objective To observe the level of circulating CD31 +/CD42b-endothelial microparticles in patients with ST-elevated myocardial infarction (STEMI),and discuss the correlation between CD31 +/CD42b-and traditional myocardial injury index.Methods A total of 22 healthy subjects and 44 patients with angiographically confirmed coronary atherosclerotic lesions collected from January 2010 to December 2010 were studied prospectively.The patients were divided into SAP (stable angina pectoris,Canadian Cardiovascular Society,CCS Ⅱ to Ⅲ ) group (n =22) and STEMI group (n =22).The level of circulating CD31 +/CD42b-endothelial microparticles was detected by flow cytometric device after admission; creatine kinase (CK) and its isoenzymes (CK-MB) were detected by using biochemical analyzer; C-reactive protein was determined by a highly sensitive latex-enhanced turbidimetric immunoassay with a low detection limit of 0.25 mg/dl (IMMAGE,Beckman Coulter; Reagent from Orion Diagn Co.Ltd.,Vantaa,Finland).Cardiac troponin I was measured by chemiluminescence immunoassay (ACCESS2 from Beckman Coulter).In 22 STEMI patients,blood sample was taken not only after admission but subsequently at 4-hour intervals during the first 48 hours.Peak levels of myocardial enzymes after injury ( creatine kinase,CK; creatine kinase MB isoenzyme,CK-MB; c troponins I,cTnI) and high sensitive C reactive protein (hs-CRP) values were determined.The correlation between circulating level of CD31 +/CD42b(-) and peak levels of myocardial biomarkers after injury were analyzed.Results The endothelial micro-particles were significantly higher in STEMI patients than those in either SAP group or normal group ( P ＜ 0.01 ),whereas there was no difference between the latter two groups.In STEMI patients studied in these cross sectional study,circulating CD31 +/CD42b-microparticles were positively correlated with peak level of myocardial biomarkers after injury.Moreover,the correlations between myocardial biomarkers after injury ( CK,CK-MB,cTnl and hs-CRP) and circulating CD31 +/CD42b-microparticles were r =0.489,P =0.021; r =0.501,P=0.018; r=0.491,P=0.02; r=0.612,P=0.002.Conclusions The level of circulating blood CD31 +/CD42b-endothelial micro-particle was expected to become a predictive marker in STEMI. Key words: Myocardial infarction; Endothelial microparticles; Myocardial injury

Comparison of inflammatory markers between diabetic and nondiabetic ST segment elevation myocardial infarction

BackgroundInflammation plays a significant role in acute coronary syndrome (ACS) and type 2 diabetes mellitus (DM). There may be similar inflammatory changes in non-DM patients with ST elevation myocardial infarction (STEMI) and DM patients with stable angina (SA), and DM patients with STEMI may have more severe changes than the former two groups. The objectives of this study were to investigate whether the level of inflammation was similar in patients with non-DM STEMI and DM SA, and to evaluate whether the changes in the level of inflammation were more severe in patients with DM STEMI compared to the other two groups. Methods and resultsA variety of inflammatory markers including: highly sensitive C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), IL-18, vascular cell adhesion molecule-1 (VCAM-1), and matrix metallopeptidase-9 (MMP-9) as well as insulin resistance were compared among the three groups: DM STEMI (90 patients), DM SA (91 patients), and non-DM STEMI (76 patients). Inflammatory marker levels were not significantly different between the DM SA and non-DM STEMI groups. However, hsCRP and IL-6 were increased in the DM STEMI compared to the DM SA patients (p=0.005 and p=0.004, respectively). In addition, hsCRP, ESR, and IL-18 were increased in the DM STEMI compared to the non-DM STEMI patients (p=0.017, p=0.020, and p=0.033, respectively). Furthermore, the fasting insulin and the homeostasis model assessment were significantly increased in the DM STEMI compared to the DM SA patients (p=0.04 and p=0.004, respectively). ConclusionsDM SA and non-DM STEMI may have similar inflammatory changes. DM STEMI may be a more severe inflammatory condition compared to patients with DM SA or non-DM STEMI.

Innate immunity markers in culprit plaques of acute myocardial infarction or stable angina

We analyzed the innate immunity markers, C-reactive protein (CRP), serum amyloid P component (SAP) and pentraxin-3 (PTX-3), and metalloproteinase-9 (MMP-9) in coronary atherectomy tissues obtained from patients with acute ST elevation myocardial infarction (STEMI) (n = 27) or stable angina (n = 15). The relative areas immunopositive for CRP and SAP were similar in the two groups. In contrast, the proportion of areas immunopositive for PTX-3 and MMP-9 was higher in the STEMI group, compared to the stable angina group. PTX-3 or MMP-9-stained areas largely overlapped with those positive for CD68. We concluded that PTX-3 plays a role in the pathogenesis of STEMI.

Early and long-term prognosis of patients with coronary artery disease treated with percutaneous coronary interventions in 2005. Experience of single large-volume PCI center

The progress which has been made in interventional cardiology contributes to the gradual improvement of the results of CHD (coronary heart disease) therapy. The aim of the study was the assessment of early and long-term prognosis in all the patients with CHD treated invasively in one large-volume PCI center in 2005. 1390 consecutive patients with CHD treated with PCI in 2005 were included in the analysis. Patients with ST-elevation myocardial infarction (STEMI) accounted for 50% of cases, patients with stable angina (SA) amounted to 25%, and patients with non-ST elevation acute coronary syndromes (NSTE-ACS) constituted 25%. Mean follow-up was 738 (±237) days. The highest mortality during the hospitalization was noted within the STEMI group(SA vs. NSTE-ACS vs. STEMI; 0% vs. 0.3% vs. 4.1%, respectively; p<0.001). The highest mortality during a 2-year follow-up was also observed in the STEMI group (SA vs. NSTE-ACS vs. STEMI, 6.3% vs. 8.5% vs. 13.8%, respectively; p<0.001). Multiple regression model showed that independent risk factors for death during the follow-up were: age, glycaemia at admission, heart rate, blood pressure, ejection fraction, STEMI, ineffective PCI (R=0.3613; F(10.131)=19.672; p<0.0001 for the model). The highest relative increase of mortality after the discharge of patients with CHD undergoing PCI referred to the patients with NSTE-ACS. However, in the real life PCI practice STEMI patients have the worst hospital and long-term prognosis. Well recognized risk factors for death in patients with CHD are still of great importance in negative prognosis of patients undergoing PCI.

Changes in Dipolar Structure of Cardiac Magnetic Field Maps after ST Elevation Myocardial Infarction

Pathological changes in cardiac electrophysiology have been investigated in coronary artery disease using magnetocardiography. Aim of this work was to examine the structure of cardiac magnetic field maps (MFM) during ventricular depolarization and repolarization in patients with acute ST elevation myocardial infarction (STEMI). Magnetocardiograms were recorded in 39 healthy subjects and 97 patients who had been successfully revascularized after STEMI. Using the Karhunen-Loeve transform, 12 eigenmaps were constructed for six intervals within the QT interval of each subject's signal-averaged data. The relative information content of the eigenmaps was compared between STEMI patients and healthy subjects. Relative nondipolar content was between 0.03% and 0.52% higher in the STEMI group, (P < 0.001 for the repolarization intervals). Information content of the first dipolar eigenmap in the STEMI group was reduced by 2.6%-11.7% (P < 0.001 for the repolarization intervals). STT interval was best able to discriminate between groups: area-under-the-curve for nondipolar content was 85.8% (P < 0.001), for the first eigenmap 91.7% (P < 0.001). Severity of infarction was reflected in lower STT interval map 1 content for patients with anterior versus posterior infarction (83%± 11% vs. 87%± 10%, P < 0.05), with wall motion disturbances (84%± 11% vs. 92%± 7%, P < 0.001) and with microvascular obstruction (81%± 12% vs. 87%± 10%, P < 0.05). Regression analysis showed that patients with lower ejection fraction tended to have less information content (P < 0.001). STEMI is associated with a loss of spatial coherence during repolarization, as quantified by principal component analysis of cardiac MFM.

Serial changes of plasma MiR-320 level in patients with acute ST elevated myocardial infarction during the process of reperfusion and its relationship with ischaemic reperfusion injury

ObjectiveTo evaluate the serial changes of plasma microRNA-320 (miR-320) level in patients with acute ST elevated myocardial infarction (STEMI) in the course of ischaemic reperfusion (I/R), explore the relation between...

Lipoprotein(a) Is the Best Single Marker in Assessing Unstable Angina Pectoris

This study evaluated whether statin therapy changed a diagnostic validity of lipid and inflammatory markers in ischemic heart disease (IHD) patients. Levels of lipids, lipoproteins, apolipoproteins, inflammatory markers, and atherogenic indexes were determined in 49 apparently healthy men and women, 82 patients having stable angina pectoris (SAP), 80 patients with unstable angina (USAP), and 106 patients with acute ST-elevation myocardial infarction (STEMI) treated or not treated with statins. Diagnostic accuracy of markers was determined by ROC curve analysis. Significantly lower apoA-I in all statin-treated groups and significantly higher apoB in statin-treated STEMI group compared to non-statin-treated groups were observed. CRP showed the best ROC characteristics in the assessment of STEMI patients. Lp(a) is better in the evaluation of SAP and USAP patients, considering that Lp(a) showed the highest area under the curve (AUC). Regarding atherogenic indexes, the highest AUC in SAP group was obtained for TG/apoB and in USAP and STEMI patients for TG/HDL-c. Statins lowered total cholesterol, LDL-c, and TG but fail to normalize apoA-I in patients with IHD.

Clinical Outcomes in Patients with Acute Left Circumflex/Obtuse Marginal Occlusion Presenting with Myocardial Infarction

Acute occlusion of left circumflex (LCx) or obtuse marginal (OM) arteries can present as ST elevation myocardial infarction (STEMI) or non-ST elevation myocardial infarction (NSTEMI). NSTEMI patients (pts) with occlusions have worse outcomes than those without occlusions, but no studies specifically examine outcomes in acute myocardial infarction (AMI) pts with LCx/OM occlusion. This study aims to define the incidence of NSTEMI in pts presenting with LCx/OM occlusion and analyzes clinical characteristics and outcomes in those presenting with NSTEMI compared to STEMI. A review of our catheterization and STEMI database was performed to identify AMI pts presenting with LCx or OM occlusion from 1/1/2007 to 7/31/2009 at the Medical College of Virginia. Patients were divided into STEMI and NSTEMI groups, and a chart review was performed. Primary end-points were in-hospital mortality (HM), cardiogenic shock (CS), and in-hospital CHF. Secondary end-points included peak CK-MB and time to catheterization, as well as combined end-points of 1-month mortality, and recurrent AMI and CHF. Fifty-six pts met inclusion criteria, 54% of whom presented with NSTEMI. STEMI pts were significantly more likely to meet the primary end-points, as well as the combined secondary end-points. They had shorter times to catheterization but larger infarct sizes. Patients with left or mixed coronary dominance were more likely to have STEMI. AMI pts with LCx/OM occlusion present with NSTEMI as often as STEMI. Those with NSTEMI have better outcomes, which may be related to right coronary dominance. Patients with acute LCx or OM occlusion present with NSTEMI as often as STEMI, but those with STEMI have worse outcomes. The difference in presentation may be related to coronary dominance.

Endothelial dysfunction in young patients with acute ST-elevation myocardial infarction

Endothelial dysfunction may be particularly important in the pathogenesis of young patients with acute myocardial infarction (AMI), because they have different clinical characteristics compared with older patients. We investigated endothelial function in relation to AMI in this young age group. From January 2005 to March 2008, 29 of 31 consecutive patients with acute ST-elevation myocardial infarction (STEMI) who were <40 years old and received direct percutaneous coronary intervention (PCI) were enrolled in the study. We compared the coronary risk factors and flow-mediated vasodilation (FMD) in the brachial artery between the acute STEMI patients and 29 age- and gender-matched controls that did not have AMI. Baseline brachial artery diameter and responses to glyceryl trinitrate were similar between the two groups. In contrast, FMD was significantly lower in the young acute STEMI group than in the control (3.47 ± 4.08 vs. 7.45 ± 4.67%, p = 0.001) and correlated with the Thrombolysis in Myocardial Infarction (TIMI) risk score. The impaired FMD in the acute STEMI group was independent of smoking, hyperlipidemia, hypertension, nitrate use, or body mass index. In multiple logistic regression analysis, only FMD and age, not traditional cardiovascular risk factors, were found to be significantly associated with acute STEMI (odds ratio = 0.75, 95% CI 0.63-0.90, p < 0.01). In conclusion, independent of conventional risk factors, severe endothelial dysfunction occurs in young acute STEMI patients and correlates with TIMI score. In addition to age, impaired FMD is the only significant factor associated with acute STEMI in this young population.

A new post-PCI scoring system for in-hospital mortality in STEMI patients

To develop a scoring system for predicting in-hospital mortality among ST-elevation myocardial infarction (STEMI) patients submitted to percutaneous intervention (PCI) on intensive cardiac care unit admission by using early and readily available clinical, angiographic and laboratory data. Prospective monocentric observational study in which we used discriminant analysis to develop a final scoring system, with prospective validation. Intensive cardiac care unit in Florence, a tertiary center. Five hundred and fifty-eight unselected patients with STEMI (group A) consecutively admitted from 1 January 2004 to 31 December 2006. A control group (group B) comprising 183 STEMI patients admitted from 1 January 2007 to 30 September 2007. In-hospital death. In group A the discriminant variables were admission Killip class, admission lactic acid, admission ejection fraction, admission troponin I (TnI), admission hemoglobin (Hb), ST-segment reduction post-PCI, systolic blood pressure on admission and chronic renal failure. We elaborated a scoring system, the Florence admission STEMI risk score, which shows an agreement of 95.7% between the observed and the estimated outcome on a statistical basis in the survival and death subgroups. We applied this score to group B (C statistics = 0.986). The Florence admission STEMI risk score incorporates anamnestic (chronic renal failure), laboratory (lactic acid, TnI and Hb), procedural and post-procedural data (ST-segment reduction post-PCI, Killip class) as well as data strictly related to infarct size (ejection fraction, TnI). This scoring system is likely to be a simple and practical tool at the bedside for risk evaluation in patients with STEMI submitted to primary PCI.

124 Comparison of patients' demographics, in-hospital and 3-year mortality rates and independent predictors of death in ST-elevation vs non-ST elevation myocardial infarction—an interventional centre experience

Introduction Acute clinical presentations of coronary artery disease include ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). Whereas STEMI presentations tend to be due to persistent thrombotic coronary artery occlusion requiring immediate revascularisation, NSTEMI presentations tend to be associated with transient thrombotic occlusion and critical stenosis of the culprit vessel which may initially be managed with aggressive anti-platelet and anti-ischaemic therapy. Aims The aim of this study was to compare the annual incidence, demographic characteristics, in-hospital mortality rates, 3-year mortality rates and independent predictors of death in patients presenting with STEMI vs NSTEMI acute coronary syndromes. Methods We performed a retrospective study of patients admitted via our casualty department between January and December 2006, with a confirmed diagnosis of STEMI or NSTEMI. All patients had prolonged cardiac chest pain or equivalent ischaemic symptoms associated with a serum troponin T rise. Categorisation into STEMI or NSTEMI was based on typical ECG changes. The variables analysed included age, gender, ethnicity, hypertension, diabetes, hyperlipidaemia, smoking, previous ischaemic heart disease and chronic renal impairment. The rates of coronary angiography, revascularisation, in-hospital death and 3-year death were also assessed. Results The study cohort consisted of 111 STEMI and 322 NSTEMI patients with a follow-up period of 3 years. Comparative data are given below in Abstract 124 Tables 1 and 2: The STEMI group were younger and had a higher proportion of men and smokers, whereas the NSTEMI group had a higher prevalence of diabetes, hypertension, previous IHD and chronic renal disease. Although STEMI patients had higher coronary angiographic and revascularisation rates than NSTEMI patients, in-hospital death rates in the two groups were similar. However, the 3-year death rate was more than twofold higher in the NSTEMI compared to STEMI group. Age (p=0.007) was the only independent predictor of 3-year mortality in STEMI patients, whereas age (p Conclusion In conclusion, our study demonstrates a significant difference in comorbidities, revascularisation rates and 3-year mortality rates among STEMI and NSTEMI patients. NSTEMI patients were older, had more comorbidities and higher death rates than STEMI patients. Age was the most robust independent predictor of death in both groups and chronic renal disease, when present, also asserted an adverse prognostic outcome.

Reversible coronary microvascular dysfunction: a common pathogenetic mechanism in Apical Ballooning or Tako-Tsubo Syndrome

To study coronary microvascular dysfunction as possible pathogenetic mechanism in Apical Ballooning Syndrome (ABS). Fifteen ABS patients (all women, 68 +/- 14 years) underwent myocardial contrast echocardiography at baseline during adenosine infusion (140 microg/kg/min) and at 1-month follow-up and compared with a group of anterior ST-elevation myocardial infarction (STEMI) patients with similar clinical characteristics. Myocardial perfusion was assessed by contrast score index (CSI) and endocardial length of contrast defect (contrast defect length, CDL), whereas myocardial dysfunction by wall motion score index (WMSI), endocardial length of contractile dysfunction (wall motion defect length, WMDL), and LV ejection fraction (LVEF). At baseline, no difference in myocardial perfusion and dysfunction were present between the two groups. During adenosine challenge, while no changes were observed in STEMI group, in ABS patients CSI, CDL, WMSI, and WMDL significantly decreased compared with baseline (P < 0.001 vs. baseline for all parameters) and LVEF significantly increased (P = 0.01 vs. baseline). At 1-month follow-up, myocardial perfusion and dysfunction completely recovered in ABS patients (P < 0.001 vs. baseline for all parameters), whereas no significant changes were observed in STEMI group. Our data strongly suggest that in ABS, irrespectively of its underlying aetiology, acute and reversible coronary microvascular vasoconstriction could represent a common pathophysiological mechanism.

The Clinical Significance of Aspirin Resistance in Patients With Chest Pain

There are conflicting data in the literature about the clinical significance of aspirin resistance. We aimed to prospectively evaluate the prevalence of biochemical aspirin resistance in patients on aspirin therapy who were admitted to the emergency clinic with chest pain. We also aimed to evaluate the relation between acute coronary syndromes (ACS) and aspirin resistance. A total of 338 patients were included in the study. Platelet reactivity was measured with the PFA-100 system (Dade Behring Inc, Deerfield, IL). Aspirin resistance determined by the PFA-100 was defined as a normal collagen and/or epinephrine closure time despite aspirin treatment (<165 s). Patients were divided into 4 groups: stable angina pectoris (SAP), unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI), ST-elevation myocardial infarction (STEMI), and rule out ACS. Aspirin resistance was found in 81 (24%) patients in all groups. Patients with ACS had significantly more aspirin resistance than patients with rule out ACS or patients with SAP (P < .001). In the SAP group, 31 (19.6%) patients; in the UA/NSTEMI group, 19 (35.8%) patients; in the STEMI group, 14 (50%) patients; and in the rule out ACS group, 17 (17.2%) patients had aspirin resistance (P < .001). In the multivariate analysis, cardiac biomarker elevation on admission to emergency department and platelet count appeared as independent factors predictive of aspirin resistance. We demonstrated that incidence of aspirin resistance was significantly higher in patients who were finally diagnosed as ACS, especially in aspirin-taking patients admitted to the emergency clinic with STEMI.

Acute coronary syndromes: clinical characteristics, management, and outcomes at the American University of Beirut Medical Center, 2002-2005.

Data on acute coronary syndromes (ACS) in developing countries is scarce. In this report, we analyze the temporal trends in the management and outcomes of a large series of ACS patients hospitalized at the American University of Beirut Medical Center (AUBMC), a tertiary referral university hospital located in a middle income Middle Eastern developing country. A total of 1025 consecutive patients hospitalized and discharged with the diagnosis of ACS were enrolled between 2002 and 2005. The utilization of evidence-based therapies and in-hospital outcomes were determined. The study enrolled 228 patients (22%) with ST-elevation myocardial infarction (STEMI), 275 patients (27%) with non-ST-elevation myocardial infarction (NSTEMI), and 522 patients (51%) with unstable angina. The STEMI group was younger and had a higher percentage of men. The utilization rates of coronary angiography and percutaneous coronary intervention (PCI) were highest in the STEMI group. Comparison to earlier ACS data (1997-1998) from the same hospital, showed an increase in the utilization of reperfusion therapy, coronary angioplasty, bypass surgery, aspirin, beta-blockers, angiotensin-converting enzymes (ACE), angiotensin receptor blockers (ARB), and statins over the past decade (P < .05). This was associated with a significant decrease in hospital mortality (13%-7.7%, P < .01). This study analyzes one of the largest series of ACS patients reported from a single center in a developing country. The utilization of evidence-based therapies in the management of ACS at AUBMC has improved significantly over the past decade with an associated decrease in hospital mortality.

Coronary lesion type, location, and characteristics of acute ST elevation myocardial infarction in young adults under 35 years of age

In the present study, we attempted to analyze the coronary artery lesion characteristics of acute ST elevation myocardial infarction (STEMI) in young patients (aged less than 35 years). We retrospectively surveyed 25 038 coronary angiography procedures, which were carried out at The Baskent University Adana Hospital from 1998 to present, to discover acute STEMI in young patients. We studied clinical risk factors and angiographic characteristics in 42 consecutive patients who underwent primary coronary angiography for acute STEMI. Control group (n=42) had no history of coronary artery disease and had angiographically proven normal coronary arteries. All patients were under 35 years of age. Angiographic features for STEMI group were collected and both groups were compared for coronary risk factors. Male sex was more prevalent in acute STEMI group when compared with control participants (83 vs. 59%, respectively; P=0.01). A significant difference was found in cigarette smoking (62 vs. 36%, respectively; P=0.007) and family history (33 vs. 16%, respectively; P=0.03) between the two groups. No statistical significance was observed between the groups in terms of hypertension, diabetes mellitus, total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels. Mean high-density lipoprotein cholesterol level was 33+/-8 mg/dl in STEMI group and 39+/-12 mg/dl in control participants (P=0.02). Young patients with acute STEMI showed a preponderance of single-vessel disease (69%) and acute anterior STEMI (60%) owing to occluded left anterior descending artery (P<0.001). We observed risk factors such as family history, smoking, and low high-density lipoprotein cholesterol levels in young adults. Acute anterior STEMI owing to occluded left anterior descending artery was more frequent. Coronary atherosclerosis was characterized by higher presence of type B and proximal lesions. The handling selection was percutaneous coronary intervention in more than half of the patients.